Polymers in 3D printing of external maxillofacial prostheses and in their retention systems

Maxillofacial defects, arising from trauma, oncological disease or congenital abnormalities, detrimentally affect daily life. Prosthetic repair offers the aesthetic and functional reconstruction with the help of materials mimicking natural tissues. 3D polymer printing enables the design of patient-specific prostheses with high structural complexity, as well as rapid and low-cost fabrication on-demand. However, 3D printing for prosthetics is still in the early stage of development and faces various challenges for widespread use. This is because the most suitable polymers for maxillofacial restoration are soft materials that do not have the required printability, mechanical strength of the printed parts, as well as functionality. This review focuses on the challenges and opportunities of 3D printing techniques for production of polymer maxillofacial prostheses using computer-aided design and modeling software. Review discusses the widely used polymers, as well as their blends and composites, which meet the most important assessment criteria, such as the physicochemical, biological, aesthetic properties and processability in 3D printing. In addition, strategies for improving the polymer properties, such as their printability, mechanical strength, and their ability to print multimaterial and architectural structures are highlighted. The current state of the prosthetic retention system is presented with a focus on actively used polymer adhesives and the recently implemented prosthesis-supporting osseointegrated implants, with an emphasis on their creation from 3D-printed polymers. The successful prosthetics is discussed in terms of the specificity of polymer materials at the restoration site. The approaches and technological prospects are also explored through the examples of the nasal, auricle and ocular prostheses, ranging from prototypes to end-use products.